Comparing the Lumbar and SGAP Flaps to the DIEP Flap Using the
BREAST-Q
by Opsomer, Dries; Vyncke, Tom; Ryx, Michelle; Stillaert,
Filip; Van Landuyt, Koenraad; Blondeel, Phillip
Plastic and
Reconstructive Surgery: September
2020 - Volume 146 - Issue 3 - p 276e-282e
Background:
The deep inferior epigastric artery perforator (DIEP) flap
is the gold standard in autologous breast reconstruction. When the abdomen is
not available, alternative donor sites can be found at the buttock, the lumbar
region, or the thighs. These flaps are referred to as second-choice flaps. This
study compares the superior gluteal artery perforator (SGAP) flap and the
lumbar artery perforator (LAP) flap to the DIEP flap using patient-reported
outcomes.
Methods:
A retrospective study was performed reviewing the records of
417 women who underwent a free flap breast reconstruction with either a DIEP,
an LAP, or an SGAP flap, between 2006 and 2018. Patients were asked to fill out
the BREAST-Q questionnaire, and patient-reported outcomes were analyzed and
correlated to the demographic information.
Results:
The response rate was 54.5 percent, with 50 LAP, 153 DIEP,
and 25 SGAP flap patients participating. When questioned about their
satisfaction with breasts and satisfaction with outcome, all three procedures
were rated similarly high. When comparing the physical well-being of the donor
site and appearance of the donor site, LAP flap patients reported significantly
lower scores than DIEP and SGAP flap patients.
Conclusions:
Patients who undergo LAP or SGAP flap breast reconstruction
seem similarly satisfied with the appearance and outcome of their free flap
breast reconstruction compared with DIEP flap patients. The donor-site
morbidity and its impact on the patient’s well-being in SGAP and LAP flap patients
have been underestimated. Despite more donor-site discomfort, the LAP and SGAP
flaps are feasible alternatives whenever the DIEP flap is not possible.
